EP4452361A1 - Compounds, systems, and techniques for removal of peripheral amyloid beta peptide with albumin binding competitors - Google Patents

Abstract

Compounds, systems, kits, methods, and/or apparatuses may be operative to reduce amyloid beta (A0) peptide in a patient, including a central nervous system (CNS) of the patient and/or a periphery (non-CNS portion) of the patient. In some embodiments, a displacer fluid comprising an A0 displacer may be introduced to the patient to bind to a blood protein, such as albumin, that binds A0 (for instance, A0 peptide or non-plaque A0 in the patient periphery. Binding of the displacer to the blood protein may facilitate more free A0 peptide (for instance, A0 monomers) in the periphery for clearance via natural processes, such as through the liver or kidneys, and/or artificial processes, such as dialysis. Increased removal of the free A0 peptide in the periphery may ultimately lead to less A0 peptide in the CNS, which may decrease A0 plaque formation in Alzheimer's Disease (AD) patients. Other embodiments are described.

Description

COMPOUNDS, SYSTEMS, AND TECHNIQUES FOR REMOVAL OF PERIPHERAL

AMYLOID BETA PEPTIDE WITH ALBUMIN BINDING COMPETITORS

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit to U.S. Provisional Application No. 63/293,122, filed December 23, 2021, the entire contents of which are incorporated herein by reference in their entirety.

FIELD

[0002] The disclosure generally relates to compounds, systems, and/or techniques for increasing the removal of target substances, including amyloid beta (AP) (for instance, Ap peptide), from the blood of a patient using a displacer compound.

BACKGROUND

[0003] Amyloid beta (AP) deposition in the central nervous system (CNS) is a hallmark of Alzheimer’s disease (AD). The accumulation of Ap into oligomers and fibrils (for instance, plaques or Ap plaques) has a key role in the neurodegenerative process and cognitive impairment of AD patients. Therapies have been tested that target Ap, for example, via eliciting an immune response against beta-amyloid plaques, blocking/dissolving and reducing Ap protofibril aggregation, or inhibit formation of Ap precursors. Most conventional therapies have focused on affecting the Ap levels in the CNS and, more particularly, the cerebrospinal fluid (CSF), with limited effectiveness. Accordingly, AD treatments may benefit from therapies that target other patient systems.

[0004] It is with respect to these and other considerations that the present improvements may be useful.

SUMMARY

[0005] This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to necessarily identify key features or essential features of the claimed subject matter, nor is it intended as an aid in determining the scope of the claimed subject matter. [0006] In one embodiment, a system may include a reservoir storing a displacer fluid comprising at least one displacer, the displacer fluid may be configured to reduce amyloid beta (AP) peptide binding to a blood protein. In some embodiments, Ap and/or Ap peptide referred to in the present disclosure may refer to Ap peptide or other forms of Ap that are not in the form of plaques (for instance, plaques in the brain, central nervous system, and/or the like, that are considered to be a cause of Alzheimer’s disease). In some embodiments, Ap peptide or nonplaque Ap may be or may include Ap monomers and/or oligomers. In various embodiments, the system may further include a fluid circuit for the displacer fluid; a pump device configured to pump the displacer fluid from the reservoir and through the fluid circuit; and a control unit configured to control the operation of the pump device to cause the flow of the displacer fluid through the fluid circuit.

[0007] In some embodiments of the system, the fluid circuit may be configured to be fluidically coupled to a circulatory system of a patient.

[0008] In various embodiments of the system, the displacer fluid may be configured to increase a clearance of Ap peptide from a periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient. In some embodiments of the system, increasing the clearance of Ap peptide may include increasing Ap peptide monomers in the blood of the patient.

[0009] In exemplary embodiments of the system, the blood protein may include albumin.

[0010] In some embodiments of the system, the at least one displacer may include one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD). In various embodiments of the system, the at least one displacer may include at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

[0011] In some embodiments of the system, the system may include a dialysis machine.

[0012] In one embodiments, a method of reducing amyloid beta Ap peptide in a patient may include providing an Ap displacer to the patient, the Ap displacer configured to bind with albumin in a periphery of the patient to increase free Ap peptide in the periphery, and removing the free Ap peptide from the periphery.

[0013] In some embodiments of the method, the Ap displacer may be configured to increase a clearance of amyloid beta Ap peptide from the periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient. In various embodiments of the method, the free Ap peptide may be removed from the periphery via a dialysis machine.

[0014] In some embodiments of the method, the Ap displacer may be provided during a dialysis treatment of the patient. In various embodiments of the method, the Ap displacer may be provided within dialysate.

[0015] In exemplary embodiments of the method, the Ap displacer may include one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD). In some embodiments of the method, the Ap displacer may include at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

[0016] In one embodiment, a method of treating Alzheimer’s Disease (AD) may include increasing a clearance of amyloid beta Ap peptide from a periphery of a patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient, wherein increasing the clearance of Ap peptide comprises reducing Ap peptide binding to albumin in the periphery.

[0017] In some embodiments of the method, the displacer may include one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD). In various embodiments of the method, the displacer may include at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03. [0018] In some embodiments of the method, the Ap displacer may be provided via a dialysis machine. In various embodiments of the method, the Ap displacer may be provided during a dialysis treatment of the patient.

[0019] In one embodiment, a kit may include a reservoir storing a displacer fluid comprising at least one displacer, the displacer fluid configured to reduce amyloid beta Ap peptide binding to albumin; and an infusion device configured to inject the displacer fluid into a patient.

[0020] In some embodiments of the kit, the displacer fluid may be configured to increase a clearance of Ap peptide from a periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of the patient. In some embodiments of the kit, increasing the clearance of Ap peptide comprising increasing Ap peptide monomers in blood of the patient. [0021] In various embodiments of the kit, the at least one displacer may include one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD). In some embodiments of the kit, the at least one displacer may include at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

[0022] In one embodiment, a method of treating Alzheimer’s Disease (AD) may include increasing a clearance of amyloid beta Ap peptide from a periphery of a patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient.

[0023] In one embodiments, a method of reducing amyloid beta Ap peptide in a patient may include providing a displacer to a patient, the displacer configured to bind with a blood protein to reduce binding of Ap peptide to the blood protein.

BRIEF DESCRIPTION OF THE DRAWINGS

[0024] By way of example, specific embodiments of the disclosed machine will now be described, with reference to the accompanying drawings, in which:

[0025] FIG. 1 illustrates a model of a patient.

[0026] FIG. 2 illustrates an example of an amyloid beta (AP) peptide structure.

[0027] FIG. 3 illustrates an example of a human serum albumin (HSA) protein structure.

[0028] FIG. 4 illustrates an example of Ap monomer-HSA complexes.

[0029] FIG. 5 illustrates a graph of Ap monomer stability.

[0030] FIG. 6A illustrates an example of a peripheral clearance of Ap peptide using a displacer according to some embodiments of the present disclosure.

[0031] FIG. 6B illustrates an example of dialysis clearance of Ap peptide using a displacer according to some embodiments of the present disclosure.

[0032] FIG. 7A illustrates an example periphery-displacer process system according to some embodiments of the present disclosure.

[0033] FIG. 7B illustrates an example periphery-displacer process kit according to some embodiments of the present disclosure.

[0034] FIG. 8 illustrates example displacer albumin binding peptides ligands (ABPs) according to some embodiments of the present disclosure. DETAILED DESCRIPTION

[0035] The present embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which several exemplary embodiments are shown. The subject matter of the present disclosure, however, may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and willfully convey the scope of the subject matter to those skilled in the art. In the drawings, like numbers refer to like elements throughout.

[0036] Various embodiments may generally be directed toward compounds, systems, methods, and/or apparatuses for performing target removal processes for removing protein-bound target substances from patient blood. In some embodiments, the target may be amyloid beta (AP). In general, in various embodiments, references to Ap and/or the removal of Ap may be or may include removal of Ap peptide that is not in the form of plaques (“non-plaque AP”). In some embodiments, Ap peptide or non-plaque Ap may be or may include Ap monomers and/or oligomers. However, the present disclosure contemplates the removal of Ap plaques using displacer fluids, processes, techniques, and/or the like according to various embodiments. In exemplary embodiments, the target may be bound to a protein. A non-limiting example of the protein may be or may include albumin. In general, a substance or target substance may be present within patient fluids in a free or unbound form and in a protein-bound form.

Conventional clearance processes (for instance, via the liver and/or kidneys) and/or dialysis may be able to remove the target substance in the unbound form, but may not be able (or at least not effectively and/or efficiently able) to remove the target substance in the protein-bound form. [0037] Ap peptide deposition in the central nervous system (CNS) is a hallmark of Alzheimer’s disease (AD). The accumulation of Ap peptide into oligomers and fibrils (for instance, as plaques or Ap plaques) has a key role in the neurodegenerative process and cognitive impairment of AD patients. A few emerging therapies targeting Ap, such as ALZT-OP1, Aducanumab, BAN2401. and CAD 106, have been used to treat patients. Other attempts have been made to elicit an immune response against beta-amyloid plaques, block, dissolve, and/or reduce beta-amyloid protofibril aggregation, or inhibit formation of beta-amyloid precursors. Most of these therapies have focused on affecting the Ap levels in the CNS, including the cerebrospinal fluid (CSF), and have been mainly ineffective. [0038] Accordingly, some embodiments provide compounds, systems, and/or treatment therapies that target periphery removal of Ap peptide. More specifically, reducing Ap (e.g., Ap peptides, non-plaque Ap, and/or the like) in the periphery (for instance, systems and organs outside of the CNS) may diminish Ap peptide levels and plaque load in the CNS. An efficient degradation of free Ap peptide (the fraction of Ap peptide not bound to plasma proteins, for instance, albumin) outside the CNS may shift the dynamic equilibrium between brain and blood in favor of the blood compartment. Increased peripheral levels of Ap peptide allows higher subsequent clearance naturally by the liver and/or kidney and/or during a dialysis process. This periphery -based treatment could reduce Ap peptide accumulation and plaque formation in the CNS. Accordingly, some embodiments may include compounds, systems, and/or techniques to facilitate a periphery-displacer process directed toward the peripheral binding competitors (or displacers) of Ap peptide to human albumin to reduce bound fraction of Ap peptide, compounds, systems, and/or techniques to facilitate periphery-displacer therapies according to some embodiments may increase periphery removal of Ap peptide alone or when coupled with existing treatment strategies.

[0039] Compounds, systems, and/or techniques to facilitate periphery-displacer processes according to some embodiments may provide multiple advantages and technical features over conventional systems. One non-limiting example of a technological advantage may include increasing the clearance of Ap peptide from patient systemic circulation. Another non-limiting technological advantage may include increased displacement of Ap peptide from human albumin using binding competitors, which may result in higher rates of Ap peptide elimination through native liver and kidney function and, ultimately, reduced amyloid burden in the CNS.

[0040] FIG. 1 illustrates an example patient. As shown in FIG. 1, Ap 130 (e.g., Ap peptide or non-plaque Ap peptide) may be present in a patient 105 in the CNS 110 and peripheral regions 120, such as the circulation system 121. Plaques 131 formed of Ap peptide 130 may be located in the CNS 110 of an AD patient 105. In the circulation system 121, Ap peptide 130 may be in a free state or may bound to a protein 132, such as albumin.

[0041] FIG. 2 illustrates an example of an amyloid beta Ap peptide structure. Ap is a peptide composed of 37-49 amino acid residues, with Ap40 (80-90%) and Ap42 (5-10%) being the most abundant species. Ap peptide is found in different forms throughout the body, for instance, as monomers, oligomers, fibrils, and plaques. The fibrillar structure is the primary component deposited in senile plaques found in the extracellular space of the brain of AD patients, mainly in the hippocampus, neocortex, and cerebral vasculature. The abnormal Ap peptide accumulation is characteristic of AD, which is a common neurodegenerative disease affecting millions of people around the globe. Ap peptide fibrils are insoluble and built predominantly by Ap42, which is thought to be more neurotoxic and prone to aggregation due to its hydrophobic and fibrillogenic nature. The production of this peptide occurs through the cleavage of the amyloid precursor protein (APP) by the enzymes P-secretase and y-secretase. Many cell types throughout the body are capable of producing Ap peptide, however, its accumulation in the form of plaques is seen in the central nervous system (CNS) only. The formation of Ap peptide oligomers is an early event in the pathogenesis of AD and levels of soluble oligomers are correlated with disease severity. Soluble oligomeric species are present in both the cerebrospinal fluid (CSF) and plasma.

[0042] The majority of Ap peptide in circulation is bound to plasma proteins, with only a small fraction in a free state (for instance, not bound or otherwise associated with another protein). Albumin is the most abundant protein present in plasma and CSF, with a much lower concentration in CSF due to blood-brain barrier (BBB) selectivity. In this context, albumin plays a key role in the distribution of Ap peptide in the periphery (i.e., outside of the CNS), including the vascular system, since Ap peptide is mostly bound to albumin in circulation. Albumin is fundamental for transportation of peptides, drugs, and fatty acids and has been shown to be a receptor for Ap monomers and soluble oligomers. By releasing Ap peptide from albumin, shorter elimination half-life of Ap peptide may occur, for example, according to pharmacokinetics principles.

[0043] Accordingly, some embodiments may provide compounds, systems, and/or techniques to facilitate a periphery-displacer process to enable and/or increase Ap peptide clearance in the periphery, for instance, non-CNS systems (the peripheral “sink hypothesis”) to treat or as part of a treatment regimen for AD. A non-limiting example, of a periphery system may be or may include the vascular system.

[0044] The efflux of cerebral Ap peptide across the BBB may occur either through lipoprotein receptor-related protein (LRP) transporters or via the less selective CSF-ISF (interstitial fluid) drainage pathways. In circulation, the clearance of Ap peptide occurs in hepatic and kidney cells, and this process is mediated mainly by apolipoprotein E (apoE) and low-density lipoprotein receptor-related protein 1 (LPR-1). Blood components also mediate peripheral clearance of Ap peptide. Secreted enzymes including insulin-degrading enzyme (IDE), neprilysin (NEP) and its homologue endothelinconverting enzyme (ECE), angiotensin converting enzyme (ACE), matrix metalloproteinase-9 (MMP-9), and plasmin, etc., are known collectively as albumin (Ab)-degrading proteases (AbDPs). In addition, monocytes can uptake Ap peptide from blood and Ap peptides are captured by erythrocytes via complement receptor 1 and transported to the liver and spleen for clearance.

[0045] The concentration of Ap peptide in the CNS is influenced by vascular Ap peptide levels. Approximately 40%-60% of brain-derived Ap peptide is cleared in the periphery. Accordingly, compounds, systems, and/or techniques operative to facilitate periphery-displacer processes according to some embodiments to increase the peripheral removal of Ap peptide and, therefore, take advantage of the peripheral capacity to clear Ap peptide, may facilitate the treatment of AD. [0046] The use of binding competitors (or displacers) may be used to increase the removal of protein bound substances. For instance, non-limiting example systems, devices, and methods for increasing the removal of uremic toxins is described in U.S. Patent Nos. 8,206,591 and 8,419,943 and U.S. Patent Application Publication No. 2019/0321537, the contents of which are each incorporated by reference as if fully set forth herein. For example, compounds (i.e., displacers) and systems may implement a displacer infusion processes for removing a target or deleterious substance bound to a protein in the blood of a patient by introducing a displacer substance into the blood under conditions in which the displacer substance replaces the target substance bound to the protein, thereby resulting in additional unbound deleterious substance in the blood, and removing unbound target substance from the blood by extracorporeal renal replacement treatment. These uremic toxin removal methods utilize displacers which share the same binding site(s) with unwanted toxins to decrease the availability of albumin binding sites, thus increasing the free fractions of these toxins which may be eliminated naturally and/or via dialysis.

[0047] Accordingly, some embodiments may provide compounds, systems, and/or techniques for periphery-displacement processes to increase peripheral clearance of Ap peptide to achieve lower levels of Ap peptide in CNS based, at least in part, on the sink hypothesis. In various embodiments, periphery-displacement processes may use displacers including, without limitation, albumin binding peptides ligands (ABPs) and albumin-binding protein domains (ABDs).

[0048] FIG. 3 illustrates an example of human serum albumin (HAS) protein structure. As shown in FIG. 3, Ap peptide may bind to albumin at one or more of binding domain site I (DI), domain site II (DII), or domain site III (Dill). Naturally, albumin is a carrier to not only low molecular weight molecules, but also to peptides and proteins such as insulin, bradykinin, and interferons, and several hundreds of other binders have been identified or predicted. Strategies to prolong peptide and small protein drugs’ half-life have been developed and tested. Among these strategies, peptides and small proteins are directly connected to high-affinity binding moieties either recombinantly or chemically during solid-phase synthesis, which non-covalently tether them to the serum proteins after injection, thus impairing their renal filtration. In various embodiments, these albumin-binding peptides (displacers) may not be linked to any drugs, but used as stand-alone substances to occupy albumin binding sites, especially AP’s albumin binding sites. The ability to bind to albumin may also allow a considerable length of half-life of displacers to function before being cleared out of human body.

[0049] ABDs were peptides originally identified as part of cell wall-anchored proteins on Grampositive bacteria. ABDs target binding site on DII of HSA and do not overlap or interfere with binding to the FcRn-binding site on albumin, which is located in Dill. Several engineered ABDs variants derived from G148-ABD, which is the C-terminal albumin binding domains of Streptococcal protein G, have been extensively studied as a biotechnological tool to improve pharmacokinetics of drugs. For example, the variant ABD035 shows high affinity for human albumin, in the 50-500 fM range. ABD035 is a potential displacer candidate according to some embodiments not only due to the high affinity with albumin, but also due to its high solubility, low aggregation, and suitable biophysical properties. Innate immune recognizes bacterial cell wall components since some are highly specific to immunoglobulin (e.g., protein G of Streptococcus). De-immunized variants, such as ABD094, have no immunogenic potential and is biologically inert, can be candidates of displacers according to some embodiments.

[0050] Studies have indicated sequences of peptides with nano-molar affinities to albumin. A non-limiting example may include the 18-amino acids peptide named 89D03 (Ac- WWEQDRDWDFDVFGGGTP-NH2) that binds tightly to human albumin (for instance, with a binding constant of around 15 nM). This high affinity may allow a considerable long resident time on albumin. The chance of Ap monomer or oligomers’ binding to albumin could be compromised when its binding sites are loaded with 89D03. A non-limiting list of illustrative displacer ABPs is included in FIG. 8.

[0051] Studies have indicated that Ap oligomers are recognized by albumin through sites that are evenly partitioned across the three albumin domains and that bind the Ab oligomers with similar dissociation constants in the 1-100 nM range. Albumin Dill has been identified as one of the binding locations of Ap peptide, for example, that the Cterm (Dill) is a key region of albumin that participates in the inhibition of Ap peptide assembly and may also facilitate the disassembly of aggregated Ap peptide, due to its specific Ap peptide binding capacity.

[0052] Interactions between these peptide displacers and Ap peptide (primarily Api-42 and 1-40 as prototypic molecules) may have an effect on albumin binding. For example, binding of ABDs or ABPs can introduce structural changes of albumin binding to Ap peptide, even when ABDs and ABPs do binding to the same domains of albumin as Ap peptide.

[0053] Circulating free Ap peptide exists in heterogeneous forms in plasma, which are primarily monomer and oligomer. Fibril and plaques have not generally been reported in plasma as the free levels of Ap peptide are low due to albumin binding. Once a substantial amount of free Ap peptide increases in plasma exceeding their critical levels of self-association, aggregation of Ap peptide may happen. The kidneys may be able to degrade some degree of Ap peptide molecules with neprilysin, which is a potent AP-degrading enzyme.

[0054] Ap peptide (for instance, Ap monomers) appear to be stable and could be cleared from circulation before aggregating into larger oligomers or fibrils. FIG. 4 illustrates a graph of Ap monomer stability. More specifically, FIG. 4 depicts a quantitative analysis of the time course of Ap oligomerization and subsequent growth steps using tetramethylrhodamine-labeled Ap. TMR is self-quenching when Ap peptide aggregates, and CD shows additive fluorescence signals when Ap peptide aggregates. As indicated in FIG. 5, time area 401 indicates that Ap monomers are stable for a sufficient amount of time to have displaced Ap peptide excreted out by the kidney before aggregation.

[0055] Ap peptide enters the brain mainly through receptors for advanced glycation end products (RAGE), a multiligand influx receptor in the immunoglobulin superfamily that is expressed on the luminal surface of brain vessels. Most tested Ap peptide molecules demonstrating abilities across BBB have been the oligomer form. Some embodiments may provide approaches to manipulate or facilitate free Ap peptide clearance in a manner favoring fast clearance with minimum or even no re-distribution across the BBB.

[0056] The structural characterization of Ap monomer-HSA complexes has been described in Choi et al., “Molecular Insights into Human Serum Albumin as a Receptor of Amyloid-P in the Extracellular Region,” Journal of the American Chemical Society, 139(43), 15437-15445 (2017), the contents of which are incorporated by reference as if fully set forth herein. FIG. 4 illustrates an example of Ap monomer-HSA complexes as described in Choi et al.

[0057] Additional albumin research includes the three-dimensional structures of albuminbinding protein ligands have been described in Zorzi et al., “Non-covalent albumin-binding ligands for extending the circulating half-life of small biotherapeutics,” Medchemcomm, 10(7): 1068-1081 (2019); results showing that the albumin oligomers are recognized by albumin through sites that are evenly partitioned across the three albumin domains and that bind the Ab oligomers with similar dissociation constants in the 1-100 nM range have been described in Milojevic et al., “Stoichiometry and affinity of the human serum albumin- Alzheimer’ s Ap peptide interactions,” Biophysical Journal, 100(1), 183-192 (2011); and results showing that the Cterm (domain 3 or Dill) is a key region of albumin that participates in the inhibition of Ap peptide assembly and also favors disassembly of already aggregated Ap peptide, due to its specific Ap peptide binding capacity, has been described in Picon-Pages et al., “Human Albumin Impairs Amyloid P-peptide Fibrillation Through its C-terminus: From docking Modeling to Protection Against Neurotoxicity in Alzheimer's disease,” Comput Struct Biotechnol J., 17:963- 971 (2019); the contents of which are each incorporated by reference as if fully set forth herein. [0058] Incubation of Ap40 and Ap42 in the absence of albumin in vitro may result in the formation of Ap fibers, however, this scenario may be different in vivo, when clearance pathways take place.

[0059] In some embodiments, periphery-displacer processes may be used in combination with treatments that facilitate Ap peptide from the brain. For example, the administration of the monoclonal antibody m266 may facilitate soluble Ap peptide efflux from the brain, acting as a peripheral sink. The use of combinatory therapies to treat AD has been encouraged given the complexity of the disease, and therapies aiming to increase Ap peptide efflux combined with improved clearance according to some embodiments may be efficient to treat AD. [0060] Various displacers may be used according to some embodiments. Non-limiting examples of displacers may include albumin binding peptide ligand (ABP); albumin-binding protein domain (ABDs); Anti-HER2; huPA inhibitor; jFXHa inhibitor; Fab, Exendin-4; G148-ABD; ABD035; ABD094; and 89D03.

[0061] Non-limiting examples of displacers may also include compounds, such as peptides, described in International Patent Application No. PCT/EP2011/051559 (the ‘559 Application) (Publication No. WO2011095545), the contents of which are incorporated by reference as if fully set forth herein. An illustrative and non-restrictive example of a compound from the ‘559 application may include an amino acid sequence that contains: a) an Arg (R) residue, in particular an Arg (R) residue that is capable of forming a hydrogen bond with the amino acid residues Asn (N) 133 & Asn (N) 135 of human serum albumin and/or capable of forming electrostatic interactions with the main-chain oxygen atoms of the Pro (P) 134 and Leu (L) 136 residues of human serum albumin; and/or b) a Trp (W) residue, in particular a Trp (W) residue that is capable of forming electrostatic interactions with the Arg (R) 138 residue of human serum albumin; and/or c) the sequence motif GGG; and preferably at least any two and more preferably all three of (i), (ii) and (iii); and that in addition contain, upstream of said Arg residue, at least one hydrophobic and/or aromatic amino acid residue such that said at least one of said hydrophobic and/or aromatic amino acid residues can bind (in)to a subpocket in (human) serum albumin that comprises (at least) one or more of the following amino acid residues of human serum albumin: V442, S443, T446, L484, L487. H488, K490, T491 and/or V493

[0062] Non-limiting examples of displacers may also include compounds SA21 described in Dennis et al., “Albumin binding as a general strategy for improving the pharmacokinetics of proteins,” J Biol Chem. 277(38):35035-43 (2002), the contents of which are incorporated by reference as if fully set forth herein.

[0063] Non-limiting examples of displacers may also include ABDs the same or similar to described in the following: (ABD035) Levy et al., “Novel exenatide analogs with peptidic albumin binding domains: potent anti-diabetic agents with extended duration of action,” PLoS One, 9(2):e87704 (2014); (Deimmunized ABD) Frejd et al, “Affibody molecules as engineered protein drugs,” Exp Mol Med. 49(3):e306 (2017); and (ABDCon) Jacobs et al., “Fusion to a highly stable consensus albumin binding domain allows for tunable pharmacokinetics,” Protein Eng Des Sei. 28(10):385-93 (2015), the contents of each of which are incorporated by reference as if fully set forth herein.

[0064] Non-limiting examples of displacers may also include Antibodies anti-HSA domains as described in the following: (AlbudAbs) Holt et al., “Anti-serum albumin domain antibodies for extending the half-lives of short lived drugs,” Protein Eng Des Sei., 21(5):283-8 (2008) and O'Connor-Semmes et al. “GSK2374697, a novel albumin-binding domain antibody (AlbudAb), extends systemic exposure of exendin-4: first study in humans— PK/PD and safety,” Clin Pharmacol Ther.96(6):704-12 (2014); and Read et al., “Apelin peptides linked to anti-serum albumin domain antibodies retain affinity in vitro and are efficacious receptor agonists in vivo,” Basic Clin Pharmacol Toxicol, 1-8 (2019); (CA645) Adams et al., “Extending the half-life of a fab fragment through generation of a humanized anti-human serum albumin Fv domain: An investigation into the correlation between affinity and serum half-life,” MAbs. 8(7): 1336-1346 (2016), the contents of each of which are incorporated by reference as if fully set forth herein. [0065] Non-limiting examples of displacers may also include compounds determined via biopanning. In general, biopanning is an affinity selection technique which selects for peptides that bind to a given target. A series of biopanning processes may produce affinity selected ligands binding to a given target, for example, human albumin. A primary structure of the peptide can then be determined, for example, by sequencing the DNA of individual clones of a bacteriophage. Peptide sequences obtained from biopanning using combinatorial peptide libraries have been stored in various databases, including ,for example, the biopanning data bank (BDB). By searching sequences binding to albumin through databases, such as BDB, candidate peptide structure can be obtained. The following Table 1 lists potential displacer candidates determined via a search in BDB:

TABLE 1

[0066] Displacers according to some embodiments may be used in various concentrations, dosages, and/or the like. In various embodiments, displacers may be used in combination with other displacers and/or other drugs as part of an AD treatment regimen. Embodiments are not limited in this context.

[0067] Some embodiments may include processes for validating displacer candidates and investigating their capabilities to compete with Ap peptide binding to albumin.

[0068] FIG. 6A illustrates an example of a periphery-displacer process for peripheral clearance of Ap peptide using a displacer according to some embodiments of the present disclosure. As shown in FIG. 6A, a patient 615 may have peripheral regions 650 (for instance, non-brain or non-CNS regions) that include, without limitation, a liver 651, kidneys 652, a vascular system 653, and/or other organs or systems.

[0069] Ap 610 (for instance, Ap peptide, Ap monomers, Ap oligomers, and/or or non-plaque Ap or Ap peptide) may be present within peripheral regions 650 in a bound and unbound form. For example, Ap peptide 610 may be bound to albumin 620. In some embodiments, a peripherydisplacer process may include introducing displacer 630 into patient 615, for instance, through an infusion, injection, oral administration, or other process. Displacer 630 may bind to at least a portion of albumin 620 in peripheral regions, leading to less bound Ap peptide 610 within peripheral regions 650. The unbound Ap peptide 610 may be cleared naturally, for instance, via the liver 651 and the kidneys 652. The introduction of displacer 630 may lead to an increase of free Ap peptide 610, which may allow for increased natural clearance of Ap peptide 610 than would occur without the introduction of displacer 630. The increased natural clearance of Ap peptide 610 may lead to a decrease in Ap peptide in the CNS, thereby reducing or eliminating the available Ap peptide in the CNS to form plaques.

[0070] FIG. 6B illustrates an example of periphery-displacer process for dialysis clearance of Ap peptide using a displacer according to some embodiments of the present disclosure. As depicted in FIG. 6B, a dialysis machine 605 may operate to cause a dialysate inflow of a dialysis fluid 604 and a dialysis outflow of the dialysate fluid along with unwanted substances 606. Patient blood 602 may include a target substance in the form of Ap peptide 610 bound to albumin 620 and free or unbound Ap peptide 210. Unbound Ap peptide 210 may cross a dialysis membrane 250 and be removed as an unwanted substance 606 with the dialysate outflow. Bound Ap peptide 210 is not able to cross dialysis membrane 650 and, therefore, cannot be removed as an unwanted substance 606 with the dialysate outflow.

[0071] In some embodiments, dialysis machine 605 may include or may be in fluid communication with a displacer container 640 operative to facilitate the infusion of a displacer 630 into patient blood 602 via a patient blood inflow. As shown in FIG. 6B, displacer 630 may compete for binding sites on albumin 620, leading to a decrease (or even an elimination) of bound Ap peptide 610 and an increase in free Ap peptide 610. An increase in free Ap peptide 610 may facilitate the removal of, or removal of a greater amount of, Ap peptide 610 from patient blood 602 than could be achieved in the absence of displacer 630.

[0072] FIG. 7A illustrates an example periphery-displacer process system according to some embodiments of the present disclosure. System 710 may be configured to perform a peripherydisplacer process according to various embodiments. In some embodiments, system 710 may be or may be a part of a diffusion device or system for flowing a fluid into a patient. In a nonlimiting example, system 710 may be or may be a part of a dialysis machine (for instance, dialysis machine 605 of FIG. 6B). System 710 may include a control unit 720 configured to control operational aspects of system 710, such as fluid flow, pumps, valves, and/or the like. Control unit 720 may be or may include processors, memories, computing devices or elements, logic devices or elements, and/or the like.

[0073] System 700 may include a reservoir 730 holding a displacer fluid comprising a displacer (“displacer fluid”) 732. In various embodiments, displacer fluid 732 may include a fluid comprising an Ap peptide displacer according to the present disclosure (“displacer fluid”). In exemplary embodiments, displacer fluid 732 may be combined with other fluids, such as a dialysis fluid (for instance, dialysate). System 700 may include a pump device 735 or other device for causing the flow of displacer fluid 732 into a patient via a patient flow circuit 715. In some embodiments, patient flow circuit 715 may be or may include an extracorporeal circuit for flowing displacer fluid 732 into patient blood.

[0074] FIG. 7B illustrates an example periphery-displacer process kit according to some embodiments of the present disclosure. Kit 710 may be configured to allow an operator (for instance, a medical professional) to perform a periphery-displacer process according to various embodiments. In some embodiments, kit 710 may include an infusion device 760 and a displacer fluid 762. In some embodiments, kit 710 may be configured with displacer fluid in a separate container 764, such as a bottle. In other embodiments, kit may be configured with displacer fluid 762 within infusion device 760. In various embodiments, displacer fluid 762 may include a fluid comprising an Ap displacer according to the present disclosure. Infusion device 760 may be or may include a device configured to allow an operator to cause the flow of displacer fluid 762 into a patient. In a non-limiting example, infusion device 760 may include a syringe or similar device.

[0075] Numerous specific details have been set forth herein to provide a thorough understanding of the embodiments. It will be understood by those skilled in the art, however, that the embodiments may be practiced without these specific details. In other instances, well-known operations, components, and circuits have not been described in detail so as not to obscure the embodiments. It can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments.

[0076] Some embodiments may be described using the expression "coupled" and "connected" along with their derivatives. These terms are not intended as synonyms for each other. For example, some embodiments may be described using the terms “connected” and/or “coupled” to indicate that two or more elements are in direct physical or electrical contact with each other. The term "coupled,” however, may also mean that two or more elements are not in direct contact with each other, but yet still co-operate or interact with each other.

[0077] Unless specifically stated otherwise, it may be appreciated that terms such as “processing,” “computing,” “calculating,” “determining,” or the like, refer to the action and/or processes of a computer or computing system, or similar electronic computing device, that manipulates and/or transforms data represented as physical quantities (e.g., electronic) within the computing system’s registers and/or memories into other data similarly represented as physical quantities within the computing system’s memories, registers or other such information storage, transmission or display devices. The embodiments are not limited in this context.

[0078] It should be noted that the methods described herein do not have to be executed in the order described, or in any particular order. Moreover, various activities described with respect to the methods identified herein can be executed in serial or parallel fashion.

[0079] Although specific embodiments have been illustrated and described herein, it should be appreciated that any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. It is to be understood that the above description has been made in an illustrative fashion, and not a restrictive one. Combinations of the above embodiments, and other embodiments not specifically described herein will be apparent to those of skill in the art upon reviewing the above description. Thus, the scope of various embodiments includes any other applications in which the above compositions, structures, and methods are used.

[0080] Although the subject matter has been described in language specific to structural features and/or methodological acts, it is to be understood that the subject matter defined in the appended claims is not necessarily limited to the specific features or acts described above. Rather, the specific features and acts described above are disclosed as example forms of implementing the claims.

Claims

CLAIMS What is claimed is:

1. A system, comprising: a reservoir storing a displacer fluid comprising at least one displacer, the displacer fluid configured to reduce amyloid beta (AP) peptide binding to a blood protein; a fluid circuit for the displacer fluid; a pump device configured to pump the displacer fluid from the reservoir and through the fluid circuit; and a control unit configured to control the operation of the pump device to cause the flow of the displacer fluid through the fluid circuit.

2. The system of claim 1, the fluid circuit configured to be fluidically coupled to a circulatory system of a patient.

3. The system of claim 2, the displacer fluid configured to increase a clearance of Ap peptide from a periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient.

4. The system of claim 3, increasing the clearance of Ap peptide comprising increasing Ap monomers in the blood of the patient.

5. The system of claim 4, the blood protein comprising albumin.

6. The system of claim 1, the at least one displacer comprising one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD).

7. The system of claim 1, the at least one displacer comprising at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

8. The system of claim 1, the system comprising a dialysis machine.

9. A method of reducing amyloid beta (AP) peptide in a patient, the method comprising: providing an Ap displacer to the patient, the Ap displacer configured to bind with albumin in a periphery of the patient to increase free Ap peptide in the periphery; and removing the free Ap peptide from the periphery.

10. The method of claim 9, the Ap displacer configured to increase a clearance of Ap peptide from the periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient.

11. The method of claim 9, the free Ap peptide removed from the periphery via a dialysis machine.

12. The method of claim 11, the Ap displacer provided during a dialysis treatment of the patient.

13. The method of claim 12, the Ap displacer provided within dialysate.

14. The method of claim 9, the Ap displacer comprising one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD).

15. The method of claim 9, the Ap displacer comprising at least one of the following: Anti- HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

16. A method of treating Alzheimer’s Disease (AD), comprising: increasing a clearance of amyloid beta (AP) peptide from a periphery of a patient, the periphery comprising at least one non-central nervous system (CNS) portion of a patient, wherein increasing the clearance of Ap peptide comprises reducing Ap peptide binding to albumin in the periphery.

17. The method of claim 16, the displacer comprising one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD).

18. The method of claim 16, the displacer comprising at least one of the following: Anti- HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.

19. The method of claim 16, the Ap displacer provided via a dialysis machine.

20. The method of claim 19, the Ap displacer provided during a dialysis treatment of the patient.

21. A kit, compri sing : a reservoir storing a displacer fluid comprising at least one displacer, the displacer fluid configured to reduce amyloid beta (AP) peptide binding to albumin; and an infusion device configured to inject the displacer fluid into a patient.

22. The kit of claim 21, the displacer fluid configured to increase a clearance of Ap peptide from a periphery of the patient, the periphery comprising at least one non-central nervous system (CNS) portion of the patient.

23. The kit of claim 22, increasing the clearance of Ap peptide comprising increasing Ap monomers in blood of the patient.

24. The kit of claim 22, the at least one displacer comprising one or more of an albumin binding peptide ligand (ABP) or an albumin-binding protein domain (ABD).

25. The kit of claim 22, the at least one displacer comprising at least one of the following: Anti-HER2, huPA inhibitor, jFXHa inhibitor, Fab, Exendin-4, G148-ABD, ABD035, ABD094, and 89D03.